Drug delivery device employing wicking release window

ABSTRACT

The present invention provides for a drug delivery device. The device can comprise at least one core with a first active pharmaceutical ingredient (API), coated with a first layer that is permeable or semi-permeable to the API, coated with a second layer that is impermeable to the API, and having a delivery window to allow passage of the API through the device and into body fluids or tissues. The device can also have a wicking material to modify the rate of transport of the API into the body fluid or tissues.

FIELD OF INVENTION

This invention relates to drug delivery devices and therapeutictreatment using the devices.

BACKGROUND

All publications herein are incorporated by reference to the same extentas if each individual publication or patent application was specificallyand individually indicated to be incorporated by reference. Thefollowing description includes information that may be useful inunderstanding the present invention. It is not an admission that any ofthe information provided herein is prior art or relevant to thepresently claimed invention, or that any publication specifically orimplicitly referenced is prior art.

Intravaginal rings, sub-dermal implants, and pessaries/suppositories areroutinely used for the delivery of drugs both topically and systemicallyto vaginal or rectal tissue. Typically, these devices are made from apolymer matrix such as silicone, and the drug is dispersed throughoutthe matrix. Release of the drug occurs by diffusion of the drugmolecules through the polymer matrix and partitioning into the fluid inthe area of the body where the device is placed (e.g., in the vaginalfluid for an intravaginal ring). Two examples of matrix release devicesare the intravaginal ring products Nuvaring, for the delivery ofcontraceptive hormones, and Estring, for the delivery of estradiol forhormone replacement therapy in menopausal women. Matrix devices providelimited control of drug release rate because the release is controlledexclusively by two factors: the relative partitioning of the drugbetween the polymer matrix material and the fluid into which it isreleased, and the diffusional characteristics of the drug within thepolymer matrix. Accordingly, there exists a need in the art for drugdelivery devices that allow for more control over the release of thedrugs.

SUMMARY OF THE INVENTION

The following embodiments and aspects thereof are described andillustrated in conjunction with compositions and methods which are meantto be exemplary and illustrative, not limiting in scope.

Various embodiments provide for a drug delivery device, comprising atleast one core comprising a first active pharmaceutical ingredient(“API”); a first coating layer that is permeable and/or semi-permeableto the API covering at least a portion of the at least one core; asecond coating layer that is impermeable to the API, covering at least aportion of the first coating layer; and a delivery window to providepassage of the API through the second coating layer.

In various embodiments, the drug delivery device can comprise at leasttwo cores, wherein a first core of the at least two core comprises thefirst API, and a second core of the at least two cores comprises asecond API.

In various embodiments, the at least one core comprises a second API.

In various embodiments, the drug delivery device can further comprise awicking material to modify the rate of transport of the API through thedelivery window.

In various embodiments, the delivery window can be completely filled bythe wicking material. In various embodiments, the delivery window can bepartially filled by the wicking material.

In various embodiments, the wicking material can be positioned throughthe delivery window passage. In various embodiments, the wickingmaterial can coat one or more inside walls of the delivery window. Invarious embodiments, the wicking material can be chemically bound to atleast a portion of the second coating layer.

In various embodiments, the drug delivery device can further comprise athird coating layer between the first coating layer and the secondcoating layer, the third coating layer covering at least a portion ofthe first coating layer to slow the release of the API.

In various embodiments, the first coating layer can comprise polylacticacid polymer, polyvinyl alcohol, or combinations thereof. In variousembodiments, the second coating layer can be selected from the groupconsisting of silicone, polyethylene (“PE”), ethylene vinyl acetate(“EVA”) and combinations thereof.

In various embodiments, the wicking material can comprise a hydrophilicpolymer or a fiber material. In various embodiments, the fiber materialcan be selected from the group consisting of silk, cotton, Nafion andcombinations thereof. In various embodiments, the wicking material cancomprise carboxymethylcellulose-hydroxyethylcellulose (“CMC-HEC”)copolymer. In various embodiments, the wicking material can comprisepolyvinylalcohol-acrylate (“PVA-MA”) copolymer. In various embodiments,the wicking material can comprise polyethylene glycol-methacrylatecopolymer.

In various embodiments, the drug delivery device can be configured as anintravaginal ring, a diaphragm, a pessary, a suppository, or a punctualplug. In various embodiments, the drug delivery device configured as anintravaginal ring wherein the API comprises tenofovir.

Various embodiments of the present invention provides for a method,comprising: providing a drug delivery device of the present invention;and administering the drug delivery device into a subject in needthereof to deliver the active pharmaceutical ingredient.

In various embodiments, a disease condition is treated or reduced.

In various embodiments, the disease condition can be selected from thegroup consisting of vaginal, uterine, pelvic, rectal, eye, ear, sinus,nasal, prostatic, and bladder.

In various embodiments, the disease condition can be selected from thegroup consisting of hyperhomocysteinemia, chronic renal failure, endstage renal disease, hemodialysis, peritoneal dialysis, vasculardementia, cardiovascular disease, stroke, cerebrovascular accidents,thrombotic disorder, hypercoagulable states, venous thrombosis, deepvein thrombosis, thrombophlebitis, thromboembolic disease, ischemicstroke, restenosis after percutaneous transluminal coronary angioplasty(PTCA), preeclampsia, vasculitis, digital ischemia, multifocalosteonecrosis, retinal vein occlusion, glaucoma, miscarriage, pregnancycomplication, placental abruption, transplantation, diabeticretinopathy, ischemic bowel disease, cerebral vein thrombosis,atherosclerosis, coronary artery disease, penile venous thrombosis,impotence, central venous thrombosis, peripheral artery disease,intermittent claudication, hemorrhagic colitis, radiation enteritis,radiation colitis, visceral ischemia, acute mesenteric ischemia, chronicmesenteric ischemia, hypertension, microangiopathy, macroangiopathy,recurrent leg ulcer, carotid stenosis, occlusive vascular disease,arterial aneurysm, abdominal aortic aneurysm, congestive heart failure,hepatopulmonary syndrome, high flow state associated with chronic liverdisease, migraine headache, vascular headache, dizziness,lightheadedness, orthostatic intolerance, postural hypotension, posturalhypotension, postural orthostatic tachycardia syndrome, idiopathicpulmonary fibrosis, pulmonary hypertension, angioedema, vaso-vagalfaints, neuroleptic malignant syndrome, learning disorder, learningdisability, insomnia, dementia, age associated memory impairment,attention deficit/hyperactivity disorder (ADHD), mild cognitiveimpairment, Alzheimer's disease, Down's syndrome, autism, Parkinson'sdisease, depression, anxiety or anxiety disorder, Asperger syndrome,glucose intolerance, diabetes, reactive hypoglycemia, metabolicsyndrome, low cortisol, hypothalamus-pituitary-adrenal dysfunction,myasthenia gravis syndrome, osteoporosis, autoimmune polyendocrinesyndrome, chronic fatigue syndrome (CFS), central sensitivity syndrome,angina, syndrome X, chronic neck pain syndrome, chronic neuromuscularpain, osteoarthritis, muscle tension headache, chronic headache, clusterheadache, temporalis tendonitis, sinusitis, atypical facial pain,trigeminal neuralgia, facial and neck pain syndrome, temperomandibularjoint syndrome, idiopathic chronic low back pain, endometriosis, painfulabdominal adhesions, chronic abdominal pain syndrome, coccydynia, pelvicfloor myalgia (levator ani spasm), polymyositis, postherpetic neuralgia,polyradiculoneuropathies, mononeuritis multiplex, reflex sympatheticdystrophy, neuropathic pain, vulvar vestibulitis, vulvodynia, chronicregional pain syndrome, osteoarthritis, fibrositis, chronic visceralpain syndrome, female urethral syndrome, painful diverticular disease,functional dyspepsia, nonulcer dyspepsia, non-erosive esophageal refluxdisease, acid-sensitive esophagus, interstitial cystitis, chronic pelvicpain syndrome, chronic urethral syndrome, chronic prostatitis, primarydysmenorrheal, dyspareunia, premenstrual syndrome (PMS), vulvodynia,ovarian remnant syndrome, ovulatory pain, pelvic congestion syndrome,myofasical pain syndrome, fibromyalgia polymyalgia rheumatica, Reiter'ssyndrome (reactive arthritis), rheumatoid arthritis,spondyloarthropathy, functional somatic syndromes, chronic regional painsyndromes, post-polio syndrome, functional somatic syndrome, rhinitis,asthma, multiple chemical sensitivity syndrome, reactive airwaydysfunction syndrome, dysnomia, sick building syndrome, asthma,idiopathic pulmonary fibrosis, idiopathic pulmonary hypertension,dysphagia, gastroparesis, functional diarrhea, chronic constipation,defecation dysfunction, dysuria, atonic bladder, neurogenic bladder,irritable bowel syndrome (IBS), ileus, chronic idiopathicpseudoobstruction, Ogilvie's syndrome, restless leg syndrome, immunedysfunction syndrome, multiple sclerosis (MS), eczema, psoriasis, atopicdermatitis, dermatitis, Crohn's disease, ulcerative colitis, ulcerativeproctitis, pouchitis, nonspecific ulcerative colitis, inflammatory boweldisease (IBD), celiac disease, diversion colitis, collagenous colitis,lymphocytic colitis, blind loop syndrome, nonalcoholic steatohepatitis(NASH), fatty liver, chronic liver disease, cirrhosis, spontaneousbacterial peritonitis, postoperative ileus, systemic lupuserythematosis, mixed connective tissue disorder, undifferentiatedconnective tissue disorder, Raynaud's phenomenon, Kawasaki syndrome,polymyositis, dermatomyositis, myositis, multiple autoimmune, syndrome,Sjögren's syndrome, lichen planus, idiopathic uveitis, gingivitis,stomatitis, otitis, necrotizing enterocolitis, intensive care unit (ICU)multiple organ failure, primary biliary cirrhosis, idiopathicmyelofibrosis, polyarteritis nodosa, eosinophilic pleural effusion,eosinophilic gastroenteritis, eosinophilic esophagitis, graft vs. hostdisease, Grave's disease, idiopathic thyroid failure, Hashimoto'sthyroiditis, autoimmune hepatitis, pancreatitis, CREST syndrome,autoimmune cholangitis, ankylosing spondylitis, atopic dermatitis,vitiligo, scleroderma, autoimmune ear disease, polyangiitis overlapsyndrome, primary sclerosing cholangitis, Gulf War syndrome, myalgicencephalomyelitis, food sensitivity, dysregulation spectrum syndrome,post-traumatic stress disorder (PTSD), benign tumor, malignant tumor,cancer and combinations thereof.

In various embodiments, the active pharmaceutical ingredient in the drugdelivery device of the present invention can be selected from the groupconsisting of atazanavir, didanosine, efavirenz, emtricitabine,lamivudine, lopinavir, nevirapine, raltegravir, ritonavir, saquinavir,stavudine, tenofovir, tenofovir disoproxil fumarate, zidovudine,acyclovir, famciclovir, valcyclovir, morphine, buprenorphine, estrogen,progestin, progesterone, cyclosporine, a calcineurin inhibitor,prostaglandin, a beta-blocker, gentamycin, corticosteroid, afluoroquinolone, insulin, an antineoplastic drug, anti-nausea drug, acorticosteroid, an antibiotic, morphine buprenorphine, a VEGF inhibitor,and combinations thereof.

In various embodiments, the drug delivery device can be adapted for aroute of administration selected from the group consisting of:sub-dermal, sub-cutaneous, systemic, local, epidural, intra-lesional,intra-tumor, intra-punctal and combinations thereof.

Other features and advantages of the invention will become apparent fromthe following detailed description, taken in conjunction with theaccompanying drawings, which illustrate, by way of example, variousfeatures of embodiments of the invention.

BRIEF DESCRIPTION OF THE FIGURES

Exemplary embodiments are illustrated in referenced figures. It isintended that the embodiments and figures disclosed herein are to beconsidered illustrative rather than restrictive.

FIG. 1 depicts a delivery device in accordance with various embodimentsof the present invention. (A) A drawing of the delivery device inintravaginal ring configuration. There are ten API pods, each with aseparate delivery window. (B) Cross-sectional view of a single API podin A showing the API core (101), permeable and/or semi-permeable polymercoating (102), and impermeable outer coating (103) with delivery window(104). No wicking material is shown in the delivery window or APIcavity.

FIG. 2 depicts a delivery device in accordance with various embodimentsof the present invention. Cross-sectional views of possible deliverydevice configurations: 203 is silicone, EVA, or other impermeablematerial that firms the outer shell of the device containing thedelivery window; 201 represents the solid API core; 202 the permeableand semi-permeable polymer coating layer or layers; 204 represents thedelivery window; and 205 the hydrogel or other wicking material. Fiveconfigurations are shown: (a) wick material filling only the deliverywindow; (b) wick material fills the delivery window and top of the APIpod cavity; (c) wick material tills the delivery window and completelysurrounds the API pod; (d) wick extends through the delivery window andinto the API pod; (e) the wick material coats the walls of the deliverywindow but does not completely fill the window space. This coating mayextend into the API pod cavity as well.

FIG. 3 depicts a delivery device in accordance with various embodimentsof the present invention. Delivery device comprises a compressed API pod(301) coated with an impermeable shell of silicone (303). A fiber wick(in this case a silk suture 305; in other embodiments, the wick can alsobe a biodegradable polymer) penetrates the core and serves as both adelivery channel for the drug to pass through the silicone shell and asuture to hold the device in place (for example in the eye).

FIG. 4 depicts (a) Structures of CMCNa and HEC and (b) representation ofCMCNa-HEC cross-linked polymer in accordance with various embodiments ofthe present invention. The DVS cross-linker is shown as thick lines, theCMCNa is shown by the thin lines with the circles representing thecharged carboxylate sites, and the HEC is represented by the thin lineswithout attached circles.

FIG. 5 depicts cross-linking reaction used in the preparation ofCMCNa-HEC hydrogels in accordance with various embodiments of thepresent invention.

FIG. 6 depicts a method for incorporation of CMC-HEC into IVRs inaccordance with various embodiments of the present invention. (A)CMC-HEC polymer solution (605) added to pod cavity, (B) CMC-HEC (605)allowed cure 24 h, (C) TFV pod (601) inserted in cavity, (D) cavitysealed with silicone (603).

FIG. 7 depicts FTIR Spectrum of cast film of CMC-HEC copolymer inaccordance with various embodiments of the present invention. The peakat 1600 cm⁻¹ is ascribed to unprotonated COO— groups on the CMCbackbone.

FIG. 8 depicts the average cumulative release for IVRs with no hydrogel(circles, 24 μg/day, n=4) and CMC-HEC hydrogel (squares, 100 μg/day,n=3) in accordance with various embodiments of the present invention.

FIG. 9 depicts photochemical cross-linking of PVA-MA macromer chains inaccordance with various embodiments of the present invention.

FIG. 10 depicts FTIR spectra of PVA, GA, and PVA-MA in DMSO solutionshowing C═O stretch at 1715 cm⁻¹ and C═C stretch at 1630 cm⁻¹ in GA andabsence of a C═O stretch in PVA in accordance with various embodimentsof the present invention. Upon macromer formation, the C═O stretch isobserved at 1710 cm⁻¹ in PVA-MA, indicating substitution of acrylate onthe PVA backbone. The C═C stretch in the PVA-MA sample is obscured byabsorption from DMSO.

FIG. 11 depicts ¹H-NMR spectra of PVA-MA macromere in DMSO-d6 inaccordance with various embodiments of the present invention. (A) 63.5kDa PVA; acrylation: 10% (theoretical), 8.8% (calculated) (B) 18 kDaPVA; acrylation: 10% (theoretical), 12.5% (calculated) (C) 63.5 kDa PVA;acrylation: 5% (theoretical), 5.1% (calculated).

FIG. 12 depicts FTIR spectra of cast films of PVA-MA before and aftercross-linking, (a) full spectrum, (b) C═O and C═C stretching region.(PI=photoinitiator) in accordance with various embodiments of thepresent invention.

FIG. 13 depicts FTIR spectrum of PVA-MA film cross-linked by irradiatingfor 0, 5, and 15 minutes in accordance with various embodiments of thepresent invention. The C═O stretch at 1708 cm⁻¹ in the un-cross-linkedfilm gradually shifts to higher energy as conjugation with the acrylateC═C double bond is lost. The C═C stretch at 1630 cm⁻¹ from the acrylatemoiety disappears as the acrylate forms a saturated ether bond with a—OH from another PVA-MA chain.

FIG. 14 depicts the average cumulative release for IVRs withun-cross-linked PVA-MA macromer (open circles, n=3) and cross-linkedPVA-MA hydrogel (closed circles, n=3) in accordance with variousembodiments of the present invention.

FIG. 15 depicts the average cumulative release for IVRs with no hydrogel(diamonds), CMC-HEC hydrogel (squares), un-cross-linked PVA-MA(triangles) and cross-linked (circles) in accordance with variousembodiments of the present invention.

DESCRIPTION OF THE INVENTION

All references cited herein are incorporated by reference in theirentirety as though fully set forth. Unless defined otherwise, technicaland scientific terms used herein have the same meaning as commonlyunderstood by one of ordinary skill in the art to which this inventionbelongs. One skilled in the art will recognize many methods andmaterials similar or equivalent to those described herein, which couldbe used in the practice of the present invention. Indeed, the presentinvention is in no way limited to the methods and materials described.For purposes of the present invention, the following terms are definedbelow.

“API” as used herein refers to active pharmaceutical ingredient.

“Core” as used herein relating to the drug delivery device refers to aformed (e.g., pressed) API composition (e.g., tablet) that is uncoated.

“Pod” as used herein refers a core (e.g., uncoated, formed API tablet)coated with one or more layers of biocompatible polymers, but without afinal sealing polymer layer and/or delivery channel.

“Drug delivery device” as used herein with respect to the presentinvention refers to a device comprising one or more pods, a sealingpolymer layer and/or one or more delivery channels. The drug deliverydevice is intended to be used either internally or externally toadminister a pharmaceutical drug compound in a controlled manner(controlled dosing rate and total dose).

“CMCNa” as used herein refers to carboxymethylcellulose, sodium salt.

“dH₂O” as used herein refers to deionized water.

“DVS” as used herein refers to divinylsulfone, a cross-linking agent.

“EVA” as used herein refers to ethylenevinylacetate.

“FTIR” as used herein refers to Fourier transform infrared spectroscopy.

“HEC” as used herein refers to hydroxyethyl cellulose.

“Excipient” as used herein refers to pharmaceutically inactivecomponents included in the drug delivery device. Excipients can includebut are not limited to dyes, flavors, binders, emollients, fillers,lubricants, and preservatives. Excipients cart be used to modify therelease or other characteristics of the API; for example, increasing thesolubility of the API, or they may be inactive, such as fillers andcolorings.

“Impermeable” as used herein in reference to a coating layer refers to alayer that will not allow passage of the effective agent at a raterequired to obtain the desired local or systemic physiological orpharmacological effect.

“Semi-permeable” as used herein in reference to a coating layer refersto a layer that will allow passage of the effective agent, but at a ratesignificantly slower than if there were no polymer or a release polymerpresent.

“Significantly slower” as used herein refers to a rate 0.5- to 5-log₁₀units slower.

“IVR” as used herein refers to intravaginal ring delivery device.

“LSR” as used herein refers to liquid silicone resin.

“NMR” as used herein refers to nuclear magnetic resonance spectroscopy.¹H-NMR as used herein refers to proton NMR spectroscopy.

“Optional” or “optionally” as used herein means that a described eventor circumstance may or may not occur, and that the description includesinstances where said event or circumstance occurs and instances in whichit does not. For example, “optionally coated with a blocking polymer”means that a blocking polymer may or may not be used in the formulation,and that the description includes both the case where a blocking polymeris present, and the case where it is omitted.

“PE” as used herein refers to polyethylene.

“PLA” as used herein refers to polylactic acid polymer, also referred toas polylactide, comprised of poly-L-lactide, poly-D-lactide, orpoly-D,L-lactide.

“PVA” as used herein refers to polyvinylalcohol polymer.

“PVA-MA” as used herein refers to polyvinylalcohol-methacrylatecopolymer polymer.

“TFV” as used herein refers to tenofovir, an antiretroviral microbicidedrug.

The disclosed invention is a drug delivery device that utilizes a uniquecombination of permeable and semi-permeable polymer coatings, releasewindow size and number in nonpermeable polymer coatings and/orstructures, and hydrogel or wicking materials to precisely control therelease of a desired API into a human patient. In various embodiments,the delivery device may be an insert such as an intravaginal ring,diaphragm, pessary, or suppository.

Drug release from the delivery devices disclosed herein may becontrolled by multiple factors, including the solubility of the drug inthe release fluid, the polymer coatings applied to the drug core, thesize and quantity of delivery window channels exposing the drug core tothe release fluid, and the characteristics of any wicking materialsapplied within the drug cavity and/or delivery channels.

FIG. 1 illustrates an embodiment of the present invention. While thedevice shown in FIG. 1 is configured as a ring, the device can be anyshape. FIG. 1A shows the delivery device in an intravaginal ringconfiguration with ten API pods, each connected to a separate deliverywindow. FIG. 1B shows the device comprising a core of an API 101, afirst coating layer 102 that is permeable and/or semi-permeable to theAPI covering the core, a second coating layer 103 that is impermeable tothe API covering the first coating layer, and a delivery window 104 toprovide passage of the API through the second coating.

FIG. 2 shows various embodiments of the device including a wickingmaterial 205, in addition to a core 201 comprising an API, a firstcoating layer 202 that is permeable and/or semi-permeable to the APIcovering the core, a second coating layer 203 that is impermeable to theAPI covering the first coating layer, and a delivery window 204 toprovide passage of the API through the second coating. FIG. 2A shows thewicking material 205 filling the delivery window 204. FIG. 2B shows thewicking material 205 filling the delivery window 204 and the top of thefirst coating layer 202. FIG. 2C shows the wicking material 205 fillingthe delivery window 204 and completely surrounding the first coatinglayer 202. FIG. 2D shows the wicking material 205 extending through thedelivery window 204 and into the core 201. FIG. 2E shows the wickingmaterial 205 coating the interior walls of the delivery window 204.

FIG. 3 shows an embodiment of the device. The core 301 comprising theAPI is surrounded by an impermeable shell of silicone 303, and a silksuture 305 penetrates the core 301 and serves as both a delivery channelfor the drug to pass through the impermeable shell 303 and a suture tohold the device in place.

FIG. 6 shows an example of a method for incorporating CMC-HEC (i.e.,wicking material) into the device. FIG. 6A shows the CMC-HEC polymersolution 605 added to the pod cavity; FIG. 6B shows the CMC-HEC polymersolution 605 curing for a 24 hour period; FIG. 6C shows the core 601comprising the API inserted into the cavity; and FIG. 6D shows thecavity sealed with silicone 603 (impermeable coating).

Various embodiments of the present invention provide for a drug deliverydevice with a solid core of API coated with polymer layers to controldrug dissolution and subsequent release rate. In various embodiments,one polymer layer is a release polymer that is permeable to the API ofinterest (this forms the API “pod”). In various embodiments, the outerlayer is a sealing material such as silicone, polyethylene (PE), orethylene vinyl acetate (EVA).

In various embodiments, there is an optional “blocking polymer” layerbetween the release polymer and outer sealing layer, coating some or allof the “pod” surface to provide for slow release of API. In variousembodiments, the blocking polymer is made of the same material as theimpermeable layer. In other embodiments, the blocking polymer is made ofa different material than the impermeable layer.

Materials that may be suitable for fabricating the coating layers of thedevice include naturally occurring or synthetic materials that arebiologically compatible with body fluids and tissues.

Naturally occurring or synthetic materials that are biologicallycompatible with body fluids and tissues and essentially insoluble inbody fluids which the material will come in contact include, but are notlimited to, polyvinyl acetate, cross-linked polyvinyl alcohol,cross-linked polyvinyl butyrate, ethylene ethylacrylate copolymer,polyethyl hexylacrylate, polyvinyl chloride, polyvinyl acetals,plasiticized ethylene vinylacetate copolymer, polyvinyl alcohol,polyvinyl acetate, ethylene vinyl chloride copolymer, polyvinyl esters,polyvinylbutyrate, polyvinyl formal, polyamides, polymethylmethacrylate,polybutylmethacrylate, plasticized polyvinyl chloride, plasticizednylon, plasticized soft nylon, plasticized polyethylene terephthalate,natural rubber, polyisoprene, polyisobutylene, polybutadiene,polyethylene, polytetrafluoroethylene, polyvinylidene chloride,polyacrylonitrile, cross-linked polyvinylpyrrolidone,polytrifluorochloroethylene, chlorinated polyethylene,poly(1,4′-isopropylidene diphenylene carbonate), vinylidene chloride,acrylonitrile copolymer, vinyl chloride-diethyl fumerale copolymer,silicone rubbers, especially the medical grade polydimethylsiloxanes,ethylene-propylene rubber, silicone-carbonate copolymers, vinylidenechloride-vinyl chloride copolymer, vinyl chloride-acrylonitrilecopolymer, vinylidene chloride-acrylonitride copolymer,hydroxypropylmethylcellulose polymer, and ethylcellulose polymer.

Specifically, the release polymer of the device of the present inventionmay be made of any of the above-listed polymers or any other polymerwhich is biologically compatible with body fluids and tissues,essentially insoluble in body fluids which the material will come incontact and permeable to the passage of the effective drug agent. Agentscoated with a layer of release polymer require either a blocking polymerlayer or a sealing layer and delivery channel to be present in order toallow passage of the agent at a rate required to obtain the desiredlocal or systemic physiological or pharmacological effect. The blockingpolymer of the device of the present invention may be made of any of theabove-listed polymers or any other polymer which is biologicallycompatible with body fluids and tissues, is essentially insoluble inbody fluids which the material will come in contact, and which isessentially impermeable or semi-permeable to the passage of theeffective agent. The term impermeable, as used herein, means that thelayer will not allow passage of the effective agent at a rate requiredto obtain the desired local or systemic physiological or pharmacologicaleffect. The term semipermeable means that the layer will allow passageof the effective agent, but at a rate significantly slower than if therewere no polymer or a release polymer present. The behavior of any givenpolymer material as permeable, semipermeable, or impermeable (i.e.release, blocking, or sealing polymer) is dependent on the properties ofthe drug, including but not limited to solubility, hydrophobicity,hydrophilicity or lipophilicity, and log p (octanol-water partitioningcoefficient).

In various embodiments, the sealing (silicone, EVA, PE) layer forms thebody of an intravaginal ring, diaphragm, intrauterine device, or othermedical implant. There may be one or more “pods” in a single ring ordevice. The sealing layer contains a delivery window that is a passagethrough the sealing layer to the API pod, allowing release of API fromthe device by diffusion through the delivery window space. There may bea single window or multiple windows for each pod. (FIG. 1). In variousembodiments, the delivery window is filled by a wicking material tomodify the rate of transport of fluid and/or API through the windowspace. Depending on the wicking material and application, the rate oftransport can be increased or decreased. A number of these possibleconfigurations are shown in FIG. 2. In various embodiments, the wick maybe a hydrophilic polymer (hydrogel). Examples of such a hydrogelmaterial include, but are not limited to, ahydroxyethylcellulose-carboxymethylcellulose copolymer, polyvinylalcohol-methacrylate copolymer, or polyethylene glycol-methacrylatecopolymer. In various embodiments, the wick can be a fiber material orbundle of fibers. Examples include: silk, cotton, and Nafion. FIG. 3shows a device of this configuration. In various embodiments, the wickcan completely fill the delivery window space, or it may only partiallyfill the window. Partial filling can be in the center of the windowpassage (such as a fiber penetrating the window), or it can be a wickingpolymer coating on the delivery window inside walls. The wickingmaterial can also be chemically bound to the silicone material asopposed to simply coating the surface. An example of this would bemodification of the exposed silanol (Si—OH) functionalities on thedelivery window walls using a poly(ethylene glycol) cross-linked polymerto improve surface wetting. In various embodiments, the hydrogelmaterial, besides filling the delivery window, may also partially fillthe drug pod cavity, providing a hydrogel layer completely surrounding,or partially surrounding, the API pod.

A large number of polymers can be used to construct the devices of thepresent invention. The requirements are that they are inert,non-immunogenic and of the desired permeability.

The impermeable layer of the device of the present invention may be madeof appropriate impermeable members of above-listed polymers, preferablysilicone, ethylene vinylacetate copolymer, or polyethylene, or any otherpolymer which is biologically compatible with body fluids and tissuesand essentially impermeable to the passage of the effective agent.

The permeable and/or semi-permeable layer of the device of the presentinvention must be biologically compatible with body fluids and tissuesand permeable to the passage of the agent or composition effective inobtaining the desired effect.

The effective agent diffuses in the direction of lower chemicalpotential, i.e., toward the exterior surface of the device. At theexterior surface of the device, equilibrium is again established. Whenthe conditions on both sides of the permeable and/or semi-permeablecoating layer are maintained constant, a steady state flux of theeffective agent will be established in accordance with Fick's taw ofDiffusion. The rate of passage of the drug through the material bydiffusion is generally dependent on the solubility of the drug therein,as well as on the thickness of the wall, among other parameters (seebelow). This means that selection of appropriate materials forfabricating the wall will be dependent on the particular drug to beused.

The rate of diffusion of the effective agent through a polymeric layerof the present invention may be determined via diffusion cell studiescarried out under sink conditions. In diffusion cell studies carried outunder sink conditions, the concentration of drug in the receptorcompartment is essentially zero when compared to the high concentrationin the donor compartment. Under these conditions, the rate of drugrelease is given by:

$\frac{Q}{t} = \frac{D \times K \times A \times D\; C}{h}$

where Q is the amount of drug released, t is time, D is the diffusioncoefficient, K is the partition coefficient, A is the surface area, DCis the difference in concentration of the drug across the membrane, andh is the thickness of the membrane.

In the case where the agent diffuses through the layer via water filledpores, there is no partitioning phenomena. Thus, K can be eliminatedfrom the equation. Under sink conditions, if release from the donor sideis very slow, the value DC is essentially constant and equal to theconcentration of the donor compartment. Release rate therefore becomesdependent on the surface area (A), thickness (h) and diffusivity (D) ofthe membrane. In the construction of the device of the presentinvention, the size (and therefore, surface area) is mainly dependent onthe size of the effective agent.

Thus, permeability values may be obtained from the slopes of a Q versustime plot. The permeability P, can be related to the diffusioncoefficient D, by:

$P = \frac{K \times D}{h}$

Exemplary microporous materials suitable for use as a permeable and/orsemi-permeable coating layer, for instance, are described in U.S. Pat.No. 4,014,335 which is incorporated herein by reference in its entirety.These materials include cross-linked polyvinyl alcohol, polyolefins orpolyvinyl chlorides or cross-linked gelatins; regenerated, insoluble,nonerodible cellulose, acylated cellulose, esterified celluloses,cellulose acetate propionate, cellulose acetate butyrate, celluloseacetate phthalate, cellulose acetate diethyl-aminoacetate;polyurethanes, polycarbonates, and microporous polymers formed byco-precipitation of a polycation and a polyanion modified insolublecollagen. Polylactic acid or cross-linked polyvinyl alcohol ispreferred. The permeable and/or semi-permeable coating layer is selectedso as to slow release of the agent from the inner core into contact witha mammalian organism, e.g., a human. The permeable and/or semi-permeablecoating layer need not provide gradual release or control of the agentinto the biological environment, however, the permeable and/orsemi-permeable coating layer may be advantageously selected to also havethat property or feature.

The devices of the present invention may be made in a wide variety ofways, such as by obtaining an effective amount of the API andcompressing the API to a core of the desired shape. For example, onceshaped, a permeable/semi-permeable and/or impermeable coating layer maybe applied to the API core creating a coated API pod. In the case of theethylene vinyl acetate, the impermeable coating layer may be applieddirectly in the form of a sheet or membrane to the outer surface of thepod. In various embodiments, the API core may have a permeable coatingapplied to its entire surface prior to coating with the impermeablecoating layer. In the case of polylactic acid or polyvinyl alcohol, thepermeable and/or semi-permeable coating may be applied by dipping theAPI core or pod one or more times in a solution containing the desiredpolymer. Optionally, the permeable and/or semi-permeable coating layermay be applied by dropping, spraying, brushing or other means of coatingthe outer surface of the core or pod with the polymer solution. Forpermeable/semipermeable coatings applied to the entire core surface, apreferable method for coating is spray-coating in a fluidized-bed or pancoating device. When using a polylactic acid or polyvinyl alcoholsolution to obtain the permeable and/or semi-permeable coating layer,the desired thickness may be obtained by applying several coats. Eachcoat may be dried prior to applying the next coat.

The following are non-limiting examples of classes of agents can beincorporated into the devices of the present invention as the API:

-   1) anesthetics and pain killing agents (e.g., lidocaine and related    compounds, benzodiazepam and related compounds, and buprenorphine    and related compounds);-   2) antiallergenics (e.g., antazoline, methapyriline,    chlorpheniramine, pyrilamine and prophenpyridamine);-   3) antibiotics [e.g., aminoglycosides (e.g., amikacin, gentamicin,    kanamycin, neomycin, netilmicin, streptomycin, tobramycin,    paromomycin), ansamycins (e.g., geldanamycin, herbimycin),    carbacephems (e.g., loracarbef), carbapenems (e.g., ertapenem,    doripenem, imipenem, cilastatin, meropenem), cephalosporins (e.g.,    first generation: cefadroxil, cefazolin, cefalotin or cefalothin,    cefalexin; second generation: cefaclor, cefamandole, cefoxitin,    cefprozil, cefuroxime; third generation: cefixime, cefdinir,    cefditoren, cefoperazone, cefotaxime, cefpodoxime, ceftazidime,    ceftibuten, ceftizoxime, ceftriaxone; fourth generation: cefepime;    fifth generation: ceftobiprole), glycopeptides (e.g., teicoplanin,    vancomycin), macrolides (e.g., azithromycin, clarithromycin,    dirithromycin, erythromycin, roxithromycin, troleandomycin,    telithromycin, spectinomycin), monobactams (e.g., aztreonam),    penicillins (e.g., amoxicillin, ampicillin, azlocillin,    carbenicillin, cloxacillin, dicloxacillin, flucloxacillin,    mezlocillin, meticillin, nafcillin, oxacillin, penicillin,    piperacillin, ticarcillin), antibiotic polypeptides (e.g.,    bacitracin, colistin, polymyxin b), quinolones (e.g., ciprofloxacin,    enoxacin, gatifloxacin, levofloxacin, lomefloxacin, moxifloxacin,    norfloxacin, ofloxacin, trovafloxacin), rifamycins (e.g., rifampicin    or rifampin, rifabutin, rifapentine, rifaximin), sulfonamides (e.g.,    mafenide, prontosil, sulfacetamide, sulfamethizole, sulfanilamide,    sulfasalazine, sulfisoxazole, trimethoprim,    trimethoprim-sulfamethoxazole (co-trimoxazole, “tmp-smx”), and    tetracyclines (e.g., demeclocycline, doxycycline, minocycline,    oxytetracycline, tetracycline) as well as arsphenamine,    chloramphenicol, clindamycin, lincomycin, ethambutol, fosfomycin,    fusidic acid, furazolidone, isoniazid, linezolid, metronidazole,    mupirocin, nitrofurantoin, platensimycin, pyrazinamide,    quinupristin/dalfopristin combination, and tinidazole]; particular    antibiotics include, but are not limited to tetracycline,    chlortetracycline, bacitracin, neomycin, polymyxin, gramicidin,    oxytetracycline, chloramphenicol, gentamycin, and erythromycin);-   4) antibacterial (e.g., sulfonamides, sulfacetamide, sulfamethizole,    sulfisoxazole, nitrofurazone and sodium propionate);-   5) anticancer or antineoplastic agents (e.g., chemotherapeutic    agents and antiproliferative agents)    -   Examples of chemotherapeutic agents include cytotoxic agents        (e.g., 5-fluorouracil, cisplatin, carboplatin, methotrexate,        daunorubicin, doxorubicin (Adriamycin®), vincristine,        vinblastine, oxorubicin, carmustine (BCNU), lomustine (CCNU),        cytarabine USP, cyclophosphamide, estramucine phosphate sodium,        altretamine, hydroxyurea, ifosfamide, procarbazine, mitomycin,        busulfan, cyclophosphamide, mitoxantrone, carboplatin,        cisplatin, interferon alfa-2a recombinant, paclitaxel,        teniposide, and streptozoci), cytotoxic akylating agents (e.g.,        busulfan, chlorambucil, cyclophosphamide, melphalan, or        ethylesulfonic acid), alkylating agents (e.g., asaley, AZQ,        BCNU, busulfan, bisulphan, carboxyphthalatoplatinum, CBDCA,        CCNU, CHIP, chlorambucil, chlorozotocin, cis-platinum,        clomesone, cyanomorpholinodoxorubicin, cyclodisone,        cyclophosphamide, dianhydrogalactitol, fluorodopan, hepsulfam,        hycanthone, iphosphamide, melphalan, methyl CCNU, mitomycin C,        mitozolamide, nitrogen mustard, PCNU, piperazine,        piperazinedione, pipobroman, porfiromycin, spirohydantoin        mustard, streptozotocin, teroxirone, tetraplatin, thiotepa,        triethylenemelamine, uracil nitrogen mustard, and Yoshi-864),        antimitotic agents (e.g., allocolchicine, Halichondrin M,        colchicine, colchicine derivatives, dolastatin 10, maytansine,        rhizoxin, paclitaxel derivatives, paclitaxel, thiocolchicine,        trityl cysteine, vinblastine sulfate, and vincristine sulfate),        plant alkaloids (e.g., actinomycin D, bleomycin, L-asparaginase,        idarubicin, vinblastine sulfate, vincristine sulfate,        mitramycin, mitomycin, daunorubicin, VP-16-213, VM-26, navelbine        and taxotere), biologicals (e.g., alpha interferon, BCG, G-CSF,        GM-CSF, and interleukin-2), topoisomerase I inhibitors (e.g.,        camptothecin, camptothecin derivatives, and        morpholinodoxorubicin), topoisomerase II inhibitors (e.g.,        mitoxantron, amonafide, m-AMSA, anthrapyrazole derivatives,        pyrazoloacridine, bisantrene HCL, daunorubicin,        deoxydoxorubicin, menogaril, N,N-dibenzyl daunomycin,        oxanthrazole, rubidazone, VM-26 and VP-16), and synthetics        (e.g., hydroxyurea, procarbazine, o,p′-DDD, dacarbazine, CCNU,        BCNU, cis-diamminedichloroplatimun, mitoxantrone, CBDCA,        levamisole, hexamethylmelamine, all-trans retinoic acid, gliadel        and porfimer sodium).    -   Examples of antiproliferative agents include alkylating agents,        antimetabolites, enzymes, biological response modifiers,        hormones and antagonists, androgen inhibitors (e.g., flutamide        and leuprolide acetate), antiestrogens (e.g., tamoxifen citrate        and analogs thereof, toremifene, droloxifene and roloxifene);        additional examples of antiproliferative agents include, but are        not limited to levamisole, gallium nitrate, granisetron,        sargramostim strontium-89 chloride, filgrastim, pilocarpine,        dexrazoxane, and ondansetron.    -   Specific anti-cancer agents include but are not limited to        5-fluorouracil, adriamycin and related compounds.-   6) anti-inflammatory agents (e.g., hydrocortisone, hydrocortisone    acetate, dexamethasone 21-phosphate, fluocinolone, medrysone,    methylprednisolone, prednisolone 21-phosphate, prednisolone acetate,    fluoromethalone, betamethasone and triminolone, 6-mannose    phosphate);-   7) anti-fungal agents (e.g., fluconazole and related compounds);-   8) antiviral agents (e.g., acyclovir and related agents, tenofovir,    maraviroc, emtricitabine, saquinavir, idoxuridine, trisodium    phosphomonoformate, trifluorothymidine, ganciclovir, DDI and AZT);-   9) cell transport/mobility impending agents (e.g., colchicine,    vincristine, cytochalasin B and related compounds);-   10) Beta-blockers: (e.g., timolol, betaxolol atenolol, etc.);-   11) Prostaglandins (e.g., latanaprost)-   12) decongestants (e.g., phenylephrine, naphazoline, and    tetrahydrazoline);-   13) HIV drugs (e.g., NNRTI, NRTI, protease inhibitor, entry    inhibitor);-   14) hormones (e.g., for contraception);-   15) hormones (e.g., for hormone replacement therapy);-   16) hormones (e.g., for infertility, assisted reproductive therapy    (ART), and in vitro fertilization (IVF))-   17) immunological response modifiers (e.g., muramyl dipeptide and    related compounds);-   18) miotics and anti-cholinesterase (e.g., pilocarpine, eserine    salicylate, carbachol, di-isopropyl fluorophosphate, phospholine    iodine, and demecarium bromide);-   19) mydriatics (e.g., atropine sulfate, cyclopentolate, homatropine,    scopolamine, tropicamide, eucatropine, and hydroxyamphetamine);-   20) peptides and proteins (e.g., cyclosporin, insulin, growth    hormones, insulin related growth factor, heat shock proteins,    antibodies and related compounds);-   21) steroidal compounds (e.g., dexamethasone, prednisolone and    related compounds);-   22) sympathomimetics (e.g., epinephrine);-   23) carbonic anhydrite inhibitors;-   24) agents to treat incontinence; and-   25) agents commonly used in topical therapy, (e.g., lactic acid for    the vaginal tract);-   26) agents that act on the syrnpatheic and/or parasympathetic    nervous systems;-   27) antipsychotics; and-   28) antidepressants.

Reference may be made to any standard pharmaceutical textbook such asRemington's Pharmaceutical Sciences for the identity of other agents.Any pharmaceutically acceptable form of such a compound may be employedin the practice of the present invention; e.g., the free base, apharmaceutically acceptable salt or derivative thereof (e.g., ester,carbamate, amide). Pharmaceutically acceptable salts, for instance,include sulfate, lactate, acetate, stearate, hydrochloride, tartrate,maleate and the like.

Various embodiments of the invention also provide for a method oftreating a subject in need thereof to obtain a desired local or systemicphysiological or pharmacological effect from an API. The method cancomprise providing a drug delivery device of the present invention; andadministering the drug delivery device to the subject and allowing theAPI to pass through the delivery window of the drug delivery device tocontact the subject. Administering can include, but not limited to,positioning, inserting, injecting, implanting, or any other methods forexposing the drug delivery device to the subject.

The drug delivery device of the present invention can also beadministered to a mammalian organism via any route of administrationknown in the art. Such routes of administration include intraocular,oral, subcutaneous, intramuscular, intraperitoneal, intranasal, dermal,and the like. In addition, one or more of the devices may beadministered at one time or more than one agent may be included in theinner core.

These methods of administration and technique for their preparation arewell known by those of ordinary skill in the art. Techniques for theirpreparation can be found in Remington's Pharmaceutical Sciences.

The drug delivery system may be administered for a sufficient period oftime and under conditions to allow treatment of the disease state ofconcern.

For localized drug delivery, the devices may be surgically implanted at,in or near the site of action. This can be the case, for example, fordevices of the present invention used in treating ocular conditions,primary tumors, rheumatic and arthritic conditions, and chronic pain.

For systemic relief, the devices may be implanted subcutaneously,intramuscularly or intraperitoneally. This can be the case when devicesare to give sustained systemic levels and avoid premature metabolism.

As would be readily understood by one skilled in the art, the amounts,materials and dimensions depend on the method of administration, theeffective agent used, the polymers used, the desired release rate andthe like. Likewise, actual release rates and release duration depend ona variety of factors in addition to the above such as the disease statebeing treated, the age and condition of the patient, the route ofadministration as well as other factors which would be readily apparentto those skilled in the art.

Particular conditions and disease conditions that are believed to beappropriate to treat in connection with various embodiments of thepresent invention include conditions and disease conditions related, butare in no way limited to the following categories: Hypercoagulablestates related to hyperhomocysteinemia (e.g., hyperhornocysteinemia,chronic renal failure, end stage renal disease, hemodialysis, peritonealdialysis, vascular dementia, cardiovascular disease, stroke,cerebrovascular accidents, thrombotic disorder, hypercoagulable states,venous thrombosis, deep vein thrombosis, thrombophlebitis,thromboembolic disease, ischemic stroke, restenosis after percutaneoustransluminal coronary angioplasty (PTCA), preeclampsia, vasculitis,digital ischemia, multifocal osteonecrosis, retinal vein occlusion,glaucoma, miscarriage, pregnancy complication, placental abruption,transplantation, diabetic retinopathy, ischemic bowel disease, cerebralvein thrombosis, atherosclerosis, coronary artery disease, penile venousthrombosis, impotence, central venous thrombosis, peripheral arterydisease, intermittent claudication, hemorrhagic colitis, radiationenteritis and colitis, visceral ischemia, acute mesenteric ischemia,chronic mesenteric ischemia, hypertension, microangiopathy,macroangiopathy, recurrent leg ulcer, carotid stenosis, occlusivevascular disease, arterial aneurysm, abdominal aortic aneurysm);Vasodilatatory states (e.g., congestive heart failure, hepatopulmonarysyndrome, high flow state associated with chronic liver disease,migraine headache, vascular headaches, dizziness, lightheadedness,orthostatic intolerance, postural hypotension, postural hypotension,postural orthostatic tachycardia syndrome, idiopathic pulmonaryfibrosis, pulmonary hypertension, angioedema, vaso-vagal faints,neuroleptic malignant syndrome); Interference with function asneurotransmitter (e.g., learning disorder, learning disability,insomnia, dementia, age associated memory impairment, attentiondeficit/hyperactivity disorder (ADHD), mild cognitive impairment,Alzheimer's disease, Down's syndrome, autism, Parkinson's disease,depression, anxiety or anxiety disorder, Asperger syndrome);interference with endocrine function (e.g., glucose intolerance,diabetes, reactive hypoglycemia, metabolic syndrome, low cortisol,hypothalamus-pituitary-adrenal dysfunction, myasthenia gravis syndrome,osteoporosis, autoimmune polyendocrine syndrome); Chronic pain syndromesdue to stimulation of N-methyl-D-asparate (NMDA) receptors leading tohypersensitivity (e.g., chronic fatigue syndrome (CFS), centralsensitivity syndrome, angina, syndrome X, chronic neck pain syndrome,chronic neuromuscular pain, osteoarthritis, muscle tension headaches,chronic headaches, cluster headache, temporalis tendonitis, sinusitis,atypical facial pain, trigeminal neuralgia, facial and neck painsyndrome, temperomandibular joint syndrome, idiopathic chronic low backpain, endometriosis, painful abdominal adhesions, chronic abdominal painsyndromes, coccydynia, pelvic floor myalgia (levator ani spasm),polymyositis, postherpetic neuralgia, polyradiculoneuropathies,mononeuritis multiplex, reflex sympathetic dystrophy, neuropathic pain,vulvar vestibulitis, vulvodynia, chronic regional pain syndrome,osteoarthritis, fibrositis, chronic visceral pain syndrome, femaleurethral syndrome, painful diverticular disease, functional dyspepsia,nonulcer dyspepsia, non-erosive esophageal reflux disease,acid-sensitive esophagus, interstitial cystitis, chronic pelvic painsyndrome, chronic urethral syndrome, chronic prostatitis, primarydysmenorrheal, dyspareunia, premenstrual syndrome (PMS), vulvodynia,ovarian remnant syndrome, ovulatory pain, pelvic congestion syndrome,myofasical pain syndrome, fibromyalgia polymyalgia rheumatica, Reiter'ssyndrome (reactive arthritis), rheumatoid arthritis,spondyloarthropathy, functional somatic syndromes, chronic regional painsyndromes, post-polio syndrome, functional somatic syndrome); Injury tonasal and respiratory tract (e.g., rhinitis, asthma, multiple chemicalsensitivity syndrome, reactive airway dysfunction syndrome, dysnomia,sick building syndrome, asthma, idiopathic pulmonary fibrosis,idiopathic pulmonary hypertension); Interference with visceral smoothmuscle contractile function (e.g., dysphagia, gastroparesis, functionaldiarrhea, chronic constipation, defecation dysfunction, dysuria, atonicbladder, neurogenic bladder, irritable bowel syndrome (IBS), ileus,chronic idiopathic pseudoobstruction, Ogilvie's syndrome); inhibition ofaerobic metabolism/ischemia disorders (e.g., restless leg syndrome,chronic fatigue syndrome); Triggering of inflammation (e.g., immunedysfunction syndrome, multiple sclerosis (MS), eczema, psoriasis, atopicdermatitis, dermatitis, Crohn's disease, ulcerative colitis, ulcerativeproctitis, pouchitis, nonspecific ulcerative colitis, inflammatory boweldisease (IBD), celiac disease, diversion colitis, collagenous colitis,lymphocytic colitis, blind loop syndrome, nonalcoholic steatohepatitis(NASH), fatty liver, chronic liver disease, cirrhosis, spontaneousbacterial peritonitis, postoperative ileus, systemic lupuserythematosis, mixed connective tissue disorder, undifferentiatedconnective tissue disorder, Raynaud's phenomenon, Kawasaki syndrome,polymyositis, dermatomyositis, myositis, multiple autoimmune, syndrome,Sjögren's syndrome, lichen plaints, idiopathic uveitis, gingivitis,stomatitis, otitis, necrotizing enterocolitis, intensive care unit (ICU)multiple organ failure, primary biliary cirrhosis, idiopathicmyelofibrosis, polyarteritis nodosa, eosinophilic pleural effusion,eosinophilic gastroenteritis, eosinophilic esophagitis, graft vs. hostdisease, Grave's disease, idiopathic thyroid failure, Hashimoto'sthyroiditis, autoimmune hepatitis, pancreatitis, CREST syndrome,autoimmune cholangitis, ankylosing spondylitis, atopic dermatitis,scleroderma, autoimmune ear disease, polyangiitis overlap syndrome,primary sclerosing cholangitis); overlap disorders (e.g., Gulf Warsyndrome, myalgic encephalomyelitis, food sensitivity, dysregulationspectrum syndrome, post-traumatic stress disorder (PTSD)); interferencewith regulation of apoptosis and proliferation (e.g., benign tumors,malignant tumors, cancer).

The invention disclosed herein can be used in a range of anatomicalcompartments to treat a range of medical conditions using a range ofactive pharmaceutical ingredients (APIs). The following examples areintended to illustrate combinations and are not meant to be restrictive.

For use in the vagina, the device can be used for (1) treating HIV orHIV prophylaxis (e.g., reduce the likelihood of acquiring HIV) with thedevice having atazanavir, didanosine, efavirenz, emtricitabine,lamivudine, lopinavir, nevirapine, raltegravir, ritonavir, saquinavir,stavudine, tenofovir, tenofovir disoproxil fumarate, or zidovudine; (2)treating HSV or HSV prophylaxis (e.g., reduce the likelihood ofacquiring HSV) with the device having acyclovir, famciclovir, orvalcyclovir; (3) treating pelvic pain with the device having morphine orbuprenorphine; (4) contraception with the device having estrogens and/orprogestins; (5) hormone replacement with the device having estrogens;and (6) treating fertility with the device having progesterone.

For use in the eye, the device can be used for (1) treating dry eye withthe device having cyclosporine or other calcineurin inhibitors; and (2)treating glaucoma with the device having prostaglandins orbeta-blockers.

For use in the ear, the device can be used for (1) treating Meniere'sdisease with the device having gentamycin or corticosteroids; and (2)otitis media with the device having antibiotics such asfluoroquinolones, or with the device having corticosteroids.

For systemic treatment, the device can be used for (1) treatment ofpsoriasis with the device having cyclosporine; and (2) treatment ofdiabetes with the device having insulin.

For local treatment, the device can be used for the treatment of tumorswith the device having antineoplastic drugs.

For systemic treatment, the device can have anti-nausea drugs.

For local treatment, the device can be used to treat ulcerative colitiswith the device having corticosteroids.

For treatment of sinus or nasal conditions, the device can be used for(1) treatment of chronic sinusitis with the device having antibiotics orcorticosteroids.

For CNS or epidural treatment, the device can be used for (1) treatmentof chronic pain with analgesics such as morphine or buprenorphine.

For intra-lesional or intra-tumor (e.g., cancer) treatment, the devicecan have antineoplastics or VEGF inhibitors.

The device can also be adapted for rectal uses as well assub-dermal/sub-cutaneous uses.

In various embodiments, the drug delivery device is adapted forintravaginal administration. In other embodiments, the drug deliverydevice is adapted for intrauterine administration. In variousembodiments, the invention provides for a method for treating a mammalhaving or prone to a vaginal or uterine disease condition, or treating amammal prophylactically to prevent or reduce the occurrence or severityof a vaginal or uterine disease condition, comprising providing a drugdelivery device of the present invention and administering atherapeutically effective amount of an agent capable of treating thevaginal or uterine disease condition via the drug delivery device. Inother embodiments, the invention provides for a method of contraception,comprising providing a drug delivery device of the present invention andadministering a therapeutically effective amount of one or morecontraceptive agents via the drug delivery device. In other embodiments,the invention provides for a method of hormone replacement; for example,to treat or reduce menopausal symptoms, comprising providing a drugdelivery device of the present invention and administering atherapeutically effective amount of one or more hormones via the drugdelivery device. In other embodiments, the invention provides for amethod of treating pelvic pain, comprising providing a drug deliverydevice of the present invention and administering a therapeuticallyeffective amount of one or more agents to treat pelvic pain via the drugdelivery device. These methods include positioning the drug deliverydevice at an area wherein release of the agent is desired and allowingthe agent to pass through the device to the desired area of treatment.Such devices provide sustained controlled release of variouscompositions to treat the vaginal or uterine disease conditions andlower the risk of detrimental local and systemic side effects.

In various embodiments, the drug delivery device is adapted forantiviral treatment. In various embodiments, the invention provides fora method for treating a mammal having or prone to a viral diseasecondition or treating a mammal prophylactically to prevent or reduce theoccurrence or severity of a viral disease condition, comprisingproviding a drug delivery device of the present invention, andadministering a therapeutically effective amount of an agent capable oftreating the viral disease condition via the drug delivery device. Themethods include positioning the drug delivery device at an area whereinrelease of the agent is desired and allowing the agent to pass throughthe device to the desired area of treatment. Such devices providesustained controlled release of various compositions to treat the rectaldisease conditions and lower the risk of detrimental local and systemicside effects.

In various embodiments, the drug delivery device is adapted for rectaladministration. In various embodiments, the invention provides for amethod for treating a mammal having or prone to a rectal diseasecondition or treating a mammal prophylactically to prevent or reduce theoccurrence or severity of a rectal disease condition, comprisingproviding a drug delivery device of the present invention, andadministering a therapeutically effective amount of an agent capable oftreating the rectal disease condition via the drug delivery device. Themethods include positioning the drug delivery device at an area whereinrelease of the agent is desired and allowing the agent to pass throughthe device to the desired area of treatment. Such devices providesustained controlled release of various compositions to treat the rectaldisease conditions and lower the risk of detrimental local and systemicside effects.

In various embodiments, the drug delivery device is adapted foradministration at, in or near the eye. In various embodiments, thedevice can be implanted at, in or near the eye. In various embodimentsthe invention provides for a method for treating a mammal having orprone to an eye disease condition, or treating a mammal prophylacticallyto prevent or reduce the occurrence or severity of an eye diseasecondition, comprising providing a drug delivery device of the presentinvention, and administering a therapeutically effective amount of anagent capable of treating the eye disease condition via the drugdelivery device. The method includes positioning a sustained releaseddrug delivery system at an area wherein release of the agent is desiredand allowing the agent to pass through the device to the desired area oftreatment. Such devices provide sustained controlled release of variouscompositions to treat the eye disease condition and lower the risk ofdetrimental local and systemic side effects. In various embodiments, themethod can involve or be configured as a punctual plug, and the API canthereby the delivered.

In various embodiments, the drug delivery device can be adapted foradministration at, in or near the ear. In various embodiments, thedevice can be implanted at, in or near the ear. In various embodiments,the invention provides for a method for treating a mammal having orprone to a hearing (or balance) impairment or treating a mammalprophylactically to prevent or reduce the occurrence or severity of ahearing (or balance) impairment that would result from inner ear cellinjury, loss, or degeneration, caused by an ototoxic agent, comprisingproviding a drug delivery device of the present invention, andadministering a therapeutically effective amount of an otoprotectiveagent via the drug delivery device. The method includes positioning asustained released drug delivery system at an area wherein release ofthe agent is desired and allowing the agent to pass through the deviceto the desired area of treatment. The invention provides a method fordirect implantation of a drug delivery device in to the inner ear in thevicinity of the oval window. Such devices provide sustained controlledrelease of various compositions to treat the inner ear and lower therisk of detrimental local and systemic side effects. Accordingly anembodiment of the invention is a method of treating a condition of theear of a mammal comprising the steps of accessing an internal anatomicalsite adjacent to the inner ear, and placing or implanting a drugdelivery device in the internal anatomical site.

In particular embodiments, the present invention provides a method fortreating inner ear diseases and their associated symptoms including, butnot limited to, congenital abnormalities such as congenital syphilis andtoxoplasmosis; viral or bacterial infections; cancers; and acquiredinner ear diseases such as Meniere's disease, sensoryneuronal hearingloss or ototoxicity. Another embodiment involves maintaining theintegrity or keeping cochlear hair cells intact within the inner ear.The goal is, therefore, to leave vestibular hair cells intact. Thus, itwould be advantageous to administer gentamicin to a patient via a localroute of administration and thereby avoid undesirable side effects ofsystemic administration.

More particularly, senility- and noise-induced loss of hearing can betreated according to the present invention. It is known that there is anapoptosis of hair cells within the cochlear ear channels associated withsome of these conditions. According to the present invention, thiscondition may be treated by administering drugs directly to the innerear in order to minimize or delay this senility- or noise-inducedhearing loss. Typical pharmaceutical compounds that may be usefulinclude the calcium channel blocking agents, cyclosporins, as well assteroids.

Devices and methods in accordance with the present invention can alsoadvantageously be used in the treatment of Meniere's disease. Particularmedications which may be used in treating this disease are mentionedabove and include, but not limited to, vasodilators, diuretics andsteroids.

Devices and methods in accordance with the present invention can alsoadvantageously allow for the gradual diffusion of medication across amembrane or into, e.g., the endolymphatic sac. By way of example and notof limitation, a hole is drilled into the endolymphatic sac or directlyinto the bone, and an implantable drug delivery device is secured intothe resulting hole. The device may be screw-shaped or otherwise shapedso as to be self-anchoring, or it may be attached by sutures, screws,staples, or other methods known in the art. At the tip of the screw maybe a permeable polymer that modulates delivery of the drug in acontrolled manner. According to another embodiment of the presentinvention, the implantable drug delivery device can be implanted in theoval window or round window, and the drug from the device can leach intothe inner ear to treat the condition for which the drug is selected.

In the methods of preventing or reducing ototoxicity of the presentinvention, various parameters associated with the patient's hearing andvestibular systems can be tested by methods well known in the art toestablish pretreatment baseline values. After administration of themethionine protective agent, and over the course of chemotherapy andafterwards, ototoxic effects can be monitored by conventional tests, andthe results can be compared to those obtained prior to treatment todetermine if any change has occurred. If any impairment is observed, theamount and/or time of administration of the protective agentadministered in conjunction with subsequent doses of theplatinum-containing chemotherapeutic agent, loop diuretic agent,aminoglycoside antibiotic, iron chelating agent, quinine, quinidine, orexposure to noise or radiation, can be adjusted so as to reduce orprevent further ototoxic changes without substantially diminishing theantineoplastic effectiveness of the platinum-containing chemotherapeuticagent or radiation, the diuretic effect of the loop diuretic agent, etc.Similar modification of treatment parameters in the case of weight loss,gastrointestinal toxicity due to either the platinum-containingchemotherapeutic agent or radiation, neurotoxicity due to either theplatinum-containing chemotherapeutic agent or radiation, alopecia due toeither the platinum-containing chemotherapeutic agent or radiation, andoverall patient condition/survival due to either the platinum-containingchemotherapeutic agent or radiation can be employed to optimize theprotective effects of the protective agent with respect thereto. Thiscan be achieved via appropriate testing and comparison of pre- andpost-treatment values, e.g., patient weight and patientphysical/medical/physiological condition, etc., with protocoladjustments being made as needed.

In various embodiments, the drug delivery device can be adapted foradministration at, in or near the nasal cavity. In various embodiments,the drug delivery devices can be implanted at, in or near the nasalcavity. In various embodiments, the invention provides for a method fortreating a mammal having or prone to a nasal disease condition, ortreating a mammal prophylactically to prevent or reduce the occurrenceor severity of a nasal disease condition, comprising providing a drugdelivery device of the present invention, and administering atherapeutically effective amount of an agent capable of treating the eyedisease condition via the drug delivery device. The method includespositioning a sustained released drug delivery system at an area whereinrelease of the agent is desired and allowing the agent to pass throughthe device to the desired area of treatment. Such devices providesustained controlled release of various compositions to treat the nasaldisease condition and lower the risk of detrimental local and systemicside effects. Accordingly, an embodiment of the invention is a method oftreating a condition of the nose or nasal cavity of a mammal comprisingthe steps of accessing an internal anatomical site adjacent to the nasalcavity, and placing or implanting a drug delivery device in the internalanatomical site.

In various embodiments, the device can be adapted for administration at,in or near the prostate. In various embodiments, the devices can beimplanted at, in or near the prostate. In various embodiments, theinvention provides for a method for treating a mammal having or prone toa prostatic disease condition, or treating a mammal prophylactically toprevent or reduce the occurrence or severity of a prostatic diseasecondition, comprising providing a drug delivery device of the presentinvention, and administering a therapeutically effective amount of anagent capable of treating the prostatic disease condition via the drugdelivery device. The method includes positioning a sustained releaseddrug delivery system at an area wherein release of the agent is desiredand allowing the agent to pass through the device to the desired area oftreatment. Such devices provide sustained controlled release of variouscompositions to treat the prostatic disease condition and lower the riskof detrimental local and systemic side effects. Accordingly, anembodiment of the invention is a method of treating a condition of theprostate of a mammal comprising the steps of accessing an internalanatomical site adjacent to the prostate, and placing or implanting adrug delivery device in the internal anatomical site.

In various embodiments, the device can be adapted for administration at,in or near the bladder. In various embodiments, the devices can beimplanted at, in or near the bladder. In various embodiments, theinvention provides for a method for treating a mammal having or prone toa bladder disease condition, or treating a mammal prophylactically toprevent or reduce the occurrence or severity of a bladder diseasecondition, comprising providing a drug delivery device of the presentinvention, and administering a therapeutically effective amount of anagent capable of treating the bladder disease condition via the drugdelivery device. In various embodiments, the bladder disease conditionis incontinence. The method includes positioning a sustained releaseddrug delivery system at an area wherein release of the agent is desiredand allowing the agent to pass through the device to the desired area oftreatment. Such devices provide sustained controlled release of variouscompositions to treat the bladder disease condition and lower the riskof detrimental local and systemic side effects. Accordingly anembodiment of the invention is a method of treating a condition of thebladder of a mammal comprising the steps of accessing an internalanatomical site adjacent to the bladder, and placing or implanting adrug delivery device in the internal anatomical site.

In various embodiments, the present invention provides for the surgicalimplantation of a drug delivery device, which includes larger scalecutting of the tissues of the patient in order to access the anatomicalsite in which the drug delivery device is to be implanted.

In various embodiments, the drug delivery device can be implantedsubcutaneously to treat, to prevent, to reduce the occurrence orseverity of the various disease conditions. In various embodiments, thedevice can maintain an effective concentration of the drug for at least30 days, 60 days, 120 days, 150 days, 180 days, and at least one year.

Yet another particular embodiment of the present invention is a methodfor delivering, for an extended period of time, an effective amount oftherapeutic agents to an affected site. Long term delivery oftherapeutic agents is a particular embodiment of the present invention.Therefore, the present invention includes a drug delivery device that isplaced within an anatomical site and is capable of delivering atherapeutic agent for at least a week. The duration of the drug deliverythrough the implanted drug delivery device to the effected site can bemonths to years. The delivery of these therapeutic agents can be linearin nature and the dosage is capable of remaining at therapeutic levelsfor weeks, months, or years.

EXAMPLES

The following examples are provided to better illustrate the claimedinvention and are not to be interpreted as limiting the scope of theinvention. To the extent that specific materials are mentioned, it ismerely for purposes of illustration and is not intended to limit theinvention. One skilled in the art may develop equivalent means orreactants without the exercise of inventive capacity and withoutdeparting from the scope of the invention.

Example 1 Intravaginal Ring with Cellulose Polymer Hydrogel to DeliverTenofovir

One example of the disclosed technology is an intravaginal ringcontaining a cellulose-based polymer hydrogel that releases themicrobicide drug tenofovir (TFV). The ring platform for delivery of TFVis illustrated in FIG. 1. A core of ca. 15 mg drug is coated with alayer of semi-permeable polymer, polylactic acid (PLA) to form a drugpod. The drug pod is then incorporated into a pre-formed silicone IVRcontaining a cavity to hold the pod and a delivery window to expose aportion of the pod to the outside surface of the ring. The ring segmentwas molded in a single step using standard liquid silicone resin (LSR)injection molding techniques. The drug pod cavity extended through tothe top of the ring. Prior to placement of the drug pod in the podcavity in the silicone ring, a delivery window in the bottom of thecavity was punched with a 1 mm diameter biopsy punch. The hydrogel wasapplied to the pod and/or cavity as described below, and the drug podswere inserted and sealed in place with room temperature curing silicone.

Carboxymethylcellulose-Hydroxyethylcellulose Copolymer (CMC-HEC)

Copolymers of cellulose-based materials have been reported withapplications in drug delivery and other applications requiringhighly-swelled, hydrophilic gels.²⁻¹¹ A copolymer ofcarboxymethylcellulose sodium (CMCNa) and hydroxyethylcellulose (HEC) asshown in FIG. 4 was prepared by crosslinking CMCNa and HEC with adivinylsulfone crosslinking agent as shown in FIG. 5. This reaction,along with a number of related polymer preparations have been reportedin the literature,^(2,5,11) but these hydrogels have not previously beenincorporated into intravaginal rings or used as wicks for drug deliverythrough a delivery window as disclosed here.

Hydrogel preparation. The CMC-HEC copolymer was prepared bycross-linking CMCNa (Fluka, Visc.=400-1000 mPa·s) and HEC (Aldrich,M_(w)=250 kDa) with divinylsulfone (DVS).^(2,4) In a typicalpreparation, 125 μL DVS (Aldrich) was dissolved in. 25 mL deionized H₂O(dH₂O). To the DVS solution was added 0.375 g CMCNa and 0.125 g HEC (3:1ratio) to give a ˜2% w/v polymer solution. The polymer solution wasstirred overnight to ensure complete dissolution, then 1 mL 0.5M KOH indH₂O was added to initiate the cross-linking reaction. Gel formationoccurs within 24 hours. Gels for FTIR analysis were cast into thin filmsimmediately after KOH addition by spreading a thin layer on a Teflonsheet and drying in air. For incorporation into IVRs, two methods wereused: gel drying and in situ gel formation.

Hydrogel drying. Dry CMC-HEC granules were obtained by allowing the gelto form in a 50 mL beaker over 24 h. Excess cross-linker and otherunreacted material was removed by successive replacements of the waterin the beaker—typically 3 replacements of 5× the weight of the gel wereused over a 48 h period. Gels were dried when necessary by removing thewater from the beaker and replacing with acetone. The acetone wassuccessively replaced with a fresh volume (2× hydrogel weight) to ensureremoval of all of the water. The acetone was evaporated in air and theresulting polymer material dried at 40° C. and ground into a coarsepowder.

In situ gel formation. Hydrogels were formed directly in the IVR drugpod cavity as shown in FIG. 6. A 75-100 μL aliquot of the gel solutionjust after addition of KOH was added to the empty drug pod cavity andallowed to fill both the delivery window and the bottom of the podcavity. The pod cavity and delivery window were sealed with a Parafilmwrap. Following 24 h curing, the Parafilm was removed and the gel washedwith dH₂O to remove excess DVS and KOH. The drug pod was then placed inthe cavity on top of the hydrogel, and the cavity sealed withroom-temperature cure silicone (Nusil MEDI-4213).

CMC-HEC Copolymer Characterization.

For the carboxymethylcellulose-hydroxyethylcellulose copolymer,cross-linking as above leads to a viscous gel solution that can be castas a thin film on a Teflon surface or dried and ground into a granular,soft powder. The FTIR spectrum of a cast film of a dessicated (dried)CMC-HEC hydrogel is shown in FIG. 7. The film was prepared by spreadinga drop of CMC-HEC polymer solution on a Teflon sheet soon after theaddition of KOH to initiate cross-linking. The film was covered, allowedto cure 24 h, then uncovered and allowed to dry. The dried film,resembling a piece of Saran Wrap film, was peeled from the Teflonsurface and the FTIR spectrum obtained directly by transmission throughthe film. Further characterization of the films by NMR spectroscopy wasattempted, but not possible as the hydrogels do not dissolve inappropriate deuterated solvents (D₂O, CD₃OD, DMSO-d6, and CD₃CN).

In Vitro Release of TFV from IVRs Containing CMCNa-HEC Hydrogel

The release of TFV from the hydrogel-containing IVR segments into VFSwas compared to release from identical IVR segments with no hydrogel.FIG. 8 shows cumulative release of TFV as a function of time in CMC-HECcontaining IVRs compared to IVRs with no hydrogel. The hydrogel acts asa wick filling the delivery window, drawing water into the drug pod andremoving the lag time for release. The hydrogels perform a number ofroles in the IVR, including: decreasing the variability in release ratefrom IVR-to-IVR, changing (i.e., either increasing or decreasing,depending on the material, implant design, and API) the release rate ofTFV from the ring, eliminating the initial lag in TFV release observedin the original ring design, and filling the delivery window andpreventing accumulation of matter within the window that may potentiallyimpact the desired release rate. The inventors anticipated that thehydrogel would decrease the variability of release rate from IVR to IVR,but, there was also an unexpected, dramatic increase in the release rate(24 μg day⁻¹ without hydrogel and 100 μg day⁻¹ with hydrogel) and anelimination of the lag time to start of release in the hydrogel IVRscompared to those without hydrogel. These properties of the CMCNa-HEChydrogel IVRs are important because they (a) provide a novel mechanismfor increasing drug release, and (b) eliminate the delay in reaching atherapeutic drug level from the time of insertion of the IVR. Theability to release a therapeutically active amount of drug isproblematic in typical matrix IVR designs where the drug must diffusethrough the silicone matrix to be released. IVRs with the design of thepresent invention allow precise control of the drug release rate bymultiple parameters: the hydrogel composition and physical properties(viscosity, extent of crosslinking), the number of drug pods, and thesize of the delivery windows. The lag period in release start typicallyexhibited by non-hydrogel containing IVRs is likely due to variabilityin the wetting of the delivery window when it is initially air-filled.

Example 2 Intravaginal Ring with Polyvinylalcohol-Acrylate (PVA-MA)Co-Polymer Hydrogel to Deliver Tenofovir

A second example of the disclosed technology is an intravaginal ringcontaining a polyvinylalcohol-acrylate (PVA-MA) polymer hydrogel thatreleases the microbicide drug tenofovir. The ring platform for thePVA-MA hydrogel IVR is identical to that described above for CMCNa-HEC,with PVA-MA in place of the CMCNa-HEC polymer.

Polyvinylalcohol-Acrylate (PVA-MA) Polymer Hydrogel Preparation andCharacterization.

PVA-MA Macromer Synthesis

Polyvinyl alcohol was modified with acrylate groups by esterification ofPVA hydroxyl groups with glycidyl methacrylate (GMA) using amodification of the method of Martens, et al.¹² The degree ofsubstitution (D.S.) is the ratio of acrylate groups to total number ofhydroxyl groups on the PVA backbone, and is controlled by the relativeratios of GMA and PVA used in the reaction. Macromers were prepared withtwo different PVA molecular weights, 18 and 63.5 kDa. In a typicalpreparation, 1 g PVA (Sigma) was dissolved in 25 mL dimethylsulfoxide(DMSO). Gentle heating was required. To the PVA solution was added 0.5 gdimethylaminopyridine (DMAP). The solution was sparged with argon (Ar)to remove O₂, and the reaction maintained under an Ar atmosphere.Glycidyl methacrylate was added stoichiometrically based on the desiredD.S., and the solution stirred 48 h in the dark, protecting the reactionfrom light by wrapping the flask in Al foil. After 48 h, the DMAP wasneutralized with 980 μL conc. HCl to prevent alkaline hydrolysis of themethacrylate ester.

The macromer was purified by dialysis against dH₂O to remove unreactedGMA and DMAP. Dialysis was carried out in dialysis tubing with a 12,000g/mol molecular weight cut-off for 2 days, changing the dH₂O twicedaily. For D.S.≤5% acrylate, the macromer is water soluble. For D.S.>5%,the macromer precipitates as a white waxy solid. The value of D.S. wasdetermined by nuclear magnetic resonance (NMR) spectroscopy. Macromersamples were dissolved in DMSO-d6, and ¹H-NMR spectra were acquired witha Varian Mercury 300 MHz instrument. The value of D.S. is calculated asthe ratio of the integration of the vinyl proton peaks (average ofintegration values of peaks at 5.50 and 6.20 ppm) to that of theunsubstituted methine moiety at 4.07-4.20 ppm, expressed as apercentage.

Cross-Linking of PVA-MA Macromer

Cross-linking was carried out on a ˜9% w/v solution of macromer in DMSO(D.S.>5%) or H₂O (D.S.<5%). The photoinitiator2-hydroxy-1-[4-(hydroxyethoxy)phenol]-2-methyl-1-propanone (Aldrich),was added at 0.05% w/v. The macromer solution was then placed in thedrug cavity/delivery window of an IVR using a micropipette as describedabove for CMCNa-HEC, or pipetted onto a glass plate to form a thin filmdisk. Photochemical cross-linking was carried out by irradiating themacromer sample using a Xe lamp UV-gun (λ=355 nm) for 1-1.5 min. Themacromer solution (un-cross-linked) could also be placed in the deliverywindow of an IVR after manufacture and cross-linked photochemically withthe drug pod in place. The cross-linking reaction is shown in FIG. 9.

PVA-MA Co-Polymer Characterization

Prior to crosslinking, PVA-MA macromer solutions in DMSO can be castinto thin films or loaded dropwise into the delivery window and drug podcavities of IVRs. The solution viscosity is controlled by concentrationof PVA-MA in solution, and can be varied from an easily flowingsolution, to a thick, syrup-like consistency. Three PVA-MA macromerswere prepared by varying either the amount of GMA relative to PVA (5% or10%) or the PVA average molecular weight (18 or 63.5 kDa). FTIR spectraof PVA, GMA, and PVA-MA macromer are shown in FIG. 10. These spectraclearly show the macromer formation as the PVA spectrum does not containa C═O stretching band in the 1700 cm-1 region, but the PVA-MA macromershows a band at 1710 cm⁻¹ indicating replacement of hydroxyl groups withthe acrylate functionality.

The degree of acrylate substitution in the PVA backbone was determinedby NMR spectroscopy as described above. The percent substitution isgiven by the ratio of the average integration of the two acrylateprotons at δ_(H) 5-6 ppm to the integration of the PVA backbone protonsat δ_(H) 4-5 ppm. ¹H-NMR spectra of the three macromers are shown inFIG. 11, along with the theoretical and measured acrylate substitutionpercentages.

PVA-MA Co-Polymer Cross-Linking

The cross-linking of PVA-MA macromers was investigated using FTIRspectroscopy. FIG. 12 shows FTIR spectra of a PVA-MA cast film beforeand after 15 min, UV-cross-linking. The spectra were acquired bytransmission through the film with no solvent; thus, the C═C stretchingbands that were obscured by DMSO absorption in the macromer solutionspectra are visible in the films. The carboxyl stretch from the acrylatemoiety at 1708 cm⁻¹ shifts to 1718 cm⁻¹ upon cross-linking due to lossof conjugation with the C═C bond. The cross-linking reaction is shown inScheme VI. The C═C stretch at 1635 cm⁻¹ disappears upon cross-linking atthe acrylate vinyl moiety. The bands at 1600 cm⁻¹ (aromatic ring C═Cstretch) and 1660 cm⁻¹ (C═O stretch) are from the photoinitiator (PI),which was not present in the uncross-linked film.

Changes in the FTIR spectrum of a PVA-MA macromer as a function ofirradiation time are shown in FIG. 13. Here, the C═C stretching banddecreases with increasing irradiation time as the vinyl group reactswith —OH on another PVA chain to form an ether cross-link. The C═Ostretch from the acrylate shifts to higher energy as the conjugationwith the C═C bond of the acrylate vinyl moiety is lost.

In Vitro Release of Tenofovir from PVA-MA Hydrogel IVRs

FIG. 14 shows the average cumulative release for a set of IVRscontaining PVA-MA hydrogel. Three IVRs contained PVA-MA co-polymer withno cross-linking and three had PVA-MA that had been cross-linked in situin the delivery window using 15 minutes photolysis with UV light. ThePVA-MA hydrogels do not release TFV as rapidly as do otherwise identicalIVRs with the CMC-HEC hydrogel. Carboxymethylcellulose is asuperabsorbant material and it is expected that it would be much morewetted in aqueous solution than PVA, potentially providing a better“wicking” matrix for rapid TFV transport through the delivery window.For the PVA-MA IVRs, an initial lag in the release rate is observed theun-cross-linked samples, but is significantly reduced in thecross-linked samples. The PVA-MA hydrogels, however, allow the extent ofcross-linking to be controlled, and allow much more precise control ofdrug release rate by modifying the hydrogel than do the CMCNa-HEChydrogels. In the PVA-MA system, the extent of cross-linking can bedetermined by the degree of methacrylate substitution (% MA per totalpolymer mass) in the PVA polymer, the size of the PVA polymer startingmaterial (which, along with D.S., determines total number of cross-linksites per PVA chain), and the length of time the PVA-MA macromere is UVirradiated (determines the fraction of available cross-link sites thatare actually cross-linked).

Comparison of Examples 1 and 2

FIG. 15 shows the average cumulative release of TFV for all threehydrogel IVRs and a non-hydrogel IVR plotted together. Theun-crosslinked PVA-MA IVR releases at nearly the same rate as the IVRwith no hydrogel. This indicates that potentially the PVA-MA macromeredissolves and is removed from the delivery window quickly, resultingessentially in a non-hydrogel IVR. Cross-linking the PVA-MA doubles therelease rate compared to the non-crosslinked PVA-MA IVR, and the CMC-HEChydrogel IVR releases at double the rate of the cross-linked PVA-MA IVR.

REFERENCES

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Various embodiments of the invention are described above in the DetailedDescription. While these descriptions directly describe the aboveembodiments, it is understood that those skilled in the art may conceivemodifications and/or variations to the specific embodiments shown anddescribed herein. Any such modifications or variations that fall withinthe purview of this description are intended to be included therein aswell. Unless specifically noted, it is the intention of the inventorsthat the words and phrases in the specification and claims be given theordinary and accustomed meanings to those of ordinary skill in theapplicable art(s).

The foregoing description of various embodiments of the invention knownto the applicant at this time of filing the application has beenpresented and is intended for the purposes of illustration anddescription. The present description is not intended to be exhaustivenor limit the invention to the precise form disclosed and manymodifications and variations are possible in the light of the aboveteachings. The embodiments described serve to explain the principles ofthe invention and its practical application and to enable others skilledin the art to utilize the invention in various embodiments and withvarious modifications as are suited to the particular use contemplated.Therefore, it is intended that the invention not be limited to theparticular embodiments disclosed for carrying out the invention.

While particular embodiments of the present invention have been shownand described, it will be obvious to those skilled in the art that,based upon the teachings herein, changes and modifications may be madewithout departing from this invention and its broader embodiments and,therefore, the appended claims are to encompass within their scope allsuch changes and modifications as are within the true spirit and scopeof this invention. It will be understood by those within the art that,in general, terms used herein are generally intended as “open” terms(e.g., the term “including” should be interpreted as “including but notlimited to,” the term “having” should be interpreted as “having atleast,” the term “includes” should be interpreted as “includes but isnot limited to,” etc.).

1.-25. (canceled)
 26. A drug delivery device, comprising: at least onecore comprising a first active pharmaceutical ingredient (“API”); afirst coating layer that is permeable and/or semi-permeable to the APIcovering at least a portion of the at least one core; a second coatinglayer that is impermeable to the API, covering at least a portion of thefirst coating layer; a third coating layer between the first coatinglayer and the second coating layer, the third coating layer covering aportion of the first coating layer; and a delivery window formed in thesecond coating layer to provide a passage of the API through the secondcoating layer.
 27. The drug delivery device of claim 26, comprising atleast two cores, wherein a first core of the at least two corescomprises the first API, and a second core of the at least two corescomprises a second API.
 28. The drug delivery device of claim 26,wherein the at least one core comprises a second API.
 29. The drugdelivery device of claim 26, wherein the API diffuses through the firstcoating layer and the third coating layer.
 30. The drug delivery deviceof claim 26, wherein the first coating layer comprises one or morematerials selected from polyvinyl alcohol, polyurethane, polylactic acidpolymer or combinations thereof.
 31. The drug delivery device of claim26, wherein the second coating layer is selected from the groupconsisting of silicone, polyethylene (“PE”), ethylene vinyl acetate(“EVA”) and combinations thereof.
 32. The drug delivery device of claim26, wherein the third coating layer comprises one or more crosslinkedpolymers selected from the group consisting of cross-linked polyvinylalcohol, cross-linked polyvinyl butyrate, cross-linked gelatins, andcross-linked polyvinylpyrrolidone.
 33. The drug delivery device of claim26, wherein the third coating layer comprises cross-linked polyvinylalcohol.
 34. The drug delivery device of claim 26, wherein a wickingmaterial coats one or more inside walls of the delivery window.
 35. Thedrug delivery device of claim 34, wherein the wicking material comprisesa hydrophilic polymer.
 36. The drug delivery device of claim 34, whereinthe wicking material comprise one or more copolymers selected from thegroup consisting of carboxymethylcellulose-hydroxyethylcellulose(“CMCHEC”) copolymer, polyvinylalcohol-methacrylate (“PVA-MA”)copolymer, and polyethylene glycol-methacrylate copolymer.
 37. The drugdelivery device of claim 26, configured as an intravaginal ring, adiaphragm, a pessary, a suppository, or a punctual plug.
 38. The drugdelivery device of claim 26, wherein the API comprises a drug selectedfrom the group consisting of leuprolide, morphine, buprenorphine,acyclovir, famciclovir, valcyclovir, atazanavir, didanosine, efavirenz,emtricitabine, lamivudine, lopinavir, nevirapine, raltegravir,ritonavir, saquinavir, stavudine, tenofovir, tenofovir disoproxilfumarate, or zidovudine, maraviroc, estradiol, estrogen, progestin,progesterone, a calcineurin inhibitor, a beta-blocker, cyclosporine,prostaglandin, gentamycin, corticosteroid, a fluoroquinolone,cyclosporine, insulin, an antineoplastic drug, an anti-nausea drug, acorticosteroid, an antibiotic or corticosteroid, an antineoplastics, aVEGF inhibitor, and combinations thereof.
 39. The drug delivery deviceof claim 26, wherein the third coating layer is semi-permeable to theAPI.
 40. A method for treating or reducing a disease condition,comprising: providing a drug delivery device of claim 26; andadministering the drug delivery device into a subject in need thereof todeliver the active pharmaceutical ingredient.
 41. The method of claim40, wherein the disease condition is selected from the group consistingof disease conditions in vaginal, uterine, pelvic, rectal, eye, ear,sinus, nasal, prostatic, and bladder diseases.
 42. The method of claim40, wherein the administering is performed using a route ofadministration selected from the group consisting of: sub-dermal,subcutaneous, systemic, local, epidural, intra-lesional, intra-tumor,intra-punctal and combinations thereof.
 43. The method of claim 40,wherein the disease condition is selected from the group consisting ofhyperhomocysteinemia, chronic renal failure, end stage renal disease,hemodialysis, peritoneal dialysis, vascular dementia, cardiovasculardisease, stroke, cerebrovascular accidents, thrombotic disorder,hypercoagulable states, venous thrombosis, deep vein thrombosis,thrombophlebitis, thromboembolic disease, ischemic stroke, restenosisafter percutaneous transluminal coronary angioplasty (PTCA),preeclampsia, vasculitis, digital ischemia, multifocal osteonecrosis,retinal vein occlusion, glaucoma, miscarriage, pregnancy complication,placental abruption, transplantation, diabetic retinopathy, ischemicbowel disease, cerebral vein thrombosis, atherosclerosis, coronaryartery disease, penile venous thrombosis, impotence, central venousthrombosis, peripheral artery disease, intermittent claudication,hemorrhagic colitis, radiation enteritis, radiation colitis, visceralischemia, acute mesenteric ischemia, chronic mesenteric ischemia,hypertension, microangiopathy, macro angiopathy, recurrent leg ulcer,carotid stenosis, occlusive vascular disease, arterial aneurysm,abdominal aortic aneurysm, congestive heart failure, hepatopulmonarysyndrome, high flow state associated with chronic liver disease,migraine headache, vascular headache, dizziness, lightheadedness,orthostatic intolerance, postural hypotension, postural hypotension,postural orthostatic tachycardia syndrome, idiopathic pulmonaryfibrosis, pulmonary hypertension, angioedema, vaso-vagal faints,neuroleptic malignant syndrome, learning disorder, learning disability,insomnia, dementia, age associated memory impairment, attentiondeficit/hyperactivity disorder (ADHD), mild cognitive impairment,Alzheimer's disease, Down's syndrome, autism, Parkinson's disease,depression, anxiety or anxiety disorder, Asperger syndrome, glucoseintolerance, diabetes, reactive hypoglycemia, metabolic syndrome, lowCortisol, hypothalamuspituitary-adrenal dysfunction, myasthenia gravissyndrome, osteoporosis, autoimmune polyendocrine syndrome, chronicfatigue syndrome (CFS), central sensitivity syndrome, angina, syndromeX, chronic neck pain syndrome, chronic neuromuscular pain,osteoarthritis, muscle tension headache, chronic headache, clusterheadache, temporalis tendonitis, sinusitis, atypical facial pain,trigeminal neuralgia, facial and neck pain syndrome, temperomandibularjoint syndrome, idiopathic chronic low back pain, endometriosis, painfulabdominal adhesions, chronic abdominal pain syndrome, coccydynia, pelvicfloor myalgia (levator ani spasm), polymyositis, postherpetic neuralgia,polyradiculoneuropathies, mononeuritis multiplex, reflex sympatheticdystrophy, neuropathic pain, vulvar vestibulitis, vulvodynia, chronicregional pain syndrome, osteoarthritis, fibrositis, chronic visceralpain syndrome, female urethral syndrome, painful diverticular disease,functional dyspepsia, nonulcer dyspepsia, nonerosive esophageal refluxdisease, acid-sensitive esophagus, interstitial cystitis, chronic pelvicpain syndrome, chronic urethral syndrome, chronic prostatitis, primarydysmenorrheal, dyspareunia, premenstrual syndrome (PMS), vulvodynia,ovarian remnant syndrome, ovulatory pain, pelvic congestion syndrome,myofasical pain syndrome, fibromyalgia polymyalgia rheumatica, Reiter'ssyndrome (reactive arthritis), rheumatoid arthritis,spondyloarthropathy, functional somatic syndromes, chronic regional painsyndromes, post-polio syndrome, functional somatic syndrome, rhinitis,colitis, ulcerative proctitis, pouchitis, nonspecific ulcerativecolitis, inflammatory bowel disease (IBD), celiac disease, diversioncolitis, collagenous colitis, lymphocytic colitis, blind loop syndrome,nonalcoholic steatohepatitis (NASH), fatty liver, chronic liver disease,cirrhosis, spontaneous bacterial peritonitis, postoperative ileus,systemic lupus erythematosis, mixed connective tissue disorder,undifferentiated connective tissue disorder, Raynaud's phenomenon,Kawasaki syndrome, polymyositis, dermatomyositis, myositis, multipleautoimmune syndrome, Sjogren's syndrome, lichen planus, idiopathicuveitis, gingivitis, stomatitis, otitis, necrotizing enterocolitis,intensive care unit (ICU) multiple organ failure, primary biliarycirrhosis, idiopathic myelofibrosis, polyarteritis nodosa, eosinophilicpleural effusion, eosinophilic gastroenteritis, eosinophilicesophagitis, graft vs. host disease, Grave's disease, idiopathic thyroidfailure, Hashimoto's thyroiditis, autoimmune hepatitis, pancreatitis,CREST syndrome, autoimmune cholangitis, ankylosing spondylitis, atopicdermatitis, vitiligo, scleroderma, autoimmune ear disease, polyangiitisoverlap syndrome, primary sclerosing cholangitis, Gulf War syndrome,myalgic encephalomyelitis, food sensitivity, dysregulation spectrumsyndrome, posttraumatic stress disorder (PTSD), benign tumor, malignanttumor, cancer and combinations thereof.